| NPI | 1619736485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY YEBOAH Family Nurse Practitioner 804-615-0129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2024-03-15 |